LucyRx has established a standard process for contracted pharmacies, pharmacy services administration organizations (PSAO), and group purchasing organizations (GPO) (“appealing party”) to submit Maximum Allowable Cost (MAC) pricing appeals to LucyRx for consideration of a MAC adjustment. MAC appeals will be reviewed in accordance with LucyRx’s standard MAC appeal process unless otherwise required by state law as outlined below. The LucyRx standard MAC Appeal Form is provided in a fillable PDF.
LucyRx’s standard process allows pharmacies to submit an appeal within 60 calendar days from the date of service. LucyRx will review the appeal and provide a determination within 10 calendar days of receipt of a valid MAC appeal. Determinations will be sent via secure email or facsimile to the appealing party. For determinations decided in favor of the pharmacy, the pharmacy will have 60 calendar days to resubmit the claim for an adjustment.
To request the LucyRx MAC List, fill out the MAC Request Form (PDF).
State Specific Requirements
If you’re a LucyRx member and have questions about your benefits, coverage, or prescription costs, our support team is available 24/7 to assist you.